CTDOL Non-Unemployment Benefits Help Request Form

CTDOL Non-Unemployment Benefits Help Request Form
THIS FORM IS NOT FOR CLAIMS OR ADJUDICATIONS QUESTIONS.

Please do not submit this form for claims or adjudications questions. Instead, visit the consumer contact center at www.FileCTUI.com for our customer service phone numbers or submit a question through Ask DOL on the bottom of that page.
*THIS IS NOT a claims or adjudications question**

Please check box to confirm
REASONS/ISSUE*
To report an unauthorized change, please fill out this form:
https://www.ctdol.state.ct.us/UI-Help/UI-Help-sec/reportunauthorizedchange.htm
For questions about the Paid FMLA please visit: www.ctpaidleave.org
Please enter broken web link:*
If you have a question regarding an overpayment or repayment of benefits please fill out this form:
https://portal.ct.gov/dol/divisions/bpcu/overpayment-form-iframe-page-english?language=en_US
If you need a copy of your annual rate notice. Please log on to ReEmployCT: https://reemploycttax.dol.ct.gov/accessct/faces/login/login_local.xhtml
Choose View correspondence.
Full Name: *

First NameLast Name
Date of Birth (for verification purposes): *

MonthDayYear
Email*
example@example.com
Phone Number*

Area CodePhone Number
Did you receive a phone call from the Connecticut Department of Labor:*

YesNo
Town*
Please describe how we can help you:*
Please verify that you are human*
Should be Empty: